Sylvia Mathews Burwell is about to become the biggest name in health care after news broke Thursday night that she will be the nominee to replace the resigning Health and Human Services Secretary Kathleen Sebelius.

If confirmed, Burwell, who is the current director of the Office and Management and Budget, will become the key figure leading implementation of the Affordable Care Act at a crucial time for the health-care law during a hotly contested election year.

Burwell has extensive administration experience that includes budget oversight for major entitlement programs, like Medicare and Medicaid. Last summer, Burwell and White House chief of staff Denis McDonough led negotiations with a group of Senate Republicans who hoped to forge a grand bargain with the administration to raise taxes and rein in spending on health and retirement programs. The talks went nowhere, but Republicans gave Burwell high marks for a bedside manner that was seen as less prickly and much less political than her predecessor Jack Lew.

After the Senate talks petered out, Burwell helped manage the first shutdown of the federal government in nearly 17 years after congressional Republicans and Democrats hit an impasse over agency spending for the current fiscal year – though the real battle was over the fate of Obamacare, rather than taxes and spending.

The government soon reopened and the parties entered negotiations over a broader budget deal that would avoid another shutdown through the fall of 2015. Burwell and the White House ceded primacy in those talks to Senate Democrats, primarily Senate Budget Committee chairman Patty Murray, mainly cheering from the sidelines as a deal was forged.

Last month, Burwell presented her first White House budget, a policy retread that broke no new ground and stands no chance of adoption. Given the standoff on budget matters, the move to DHHS represents a significant promotion into the heart of the Obama administration’s efforts to secure the president’s legacy.

Burwell had served the Clinton administration for all eight years, first as the staff director of the National Economic Council in 1993, and then as Robert Rubin’s chief of staff at the Treasury Department of from 1995 to 1997. She then moved back to the White House to serve as deputy chief of staff before becoming deputy director of OMB from 1998 to 2001.

After leaving the Clinton White House, she served in the foundation world. First, she held a leadership position in the Bill and Melinda Gates Foundation between 2002 and 2011, before she was picked to lead the Walmart Foundation in 2011. A previous Wonkblog post dives deeper into Burwell’s background last year when she was tapped to head OMB.

The Senate unanimously confirmed Burwell to lead OMB in April 2013, less than two months after her nomination to lead the agency.

In an Oct. 19 interview with the Washington Post, she said the 16-day government shutdown would have a negative impact on employee morale, and she worried about the government’s ability to recruit workers.

“I don’t actually think it will lead to decreased productivity,” she said at the time. “What I think instead it will lead to are issues with regard to maintaining high-potential people in the federal workforce and our ability to attract the greatest talent.”

Under Burwell's direction, OMB last month shielded an Obamacare subsidy program from automatic sequestration cuts. Cost-sharing subsidies under the health-care law had been subject to about $290 million in sequester cuts this year, but OMB said the cuts will not apply in 2015.

Her OMB tenure has been free of controversy, but her nomination to lead HHS is bound to open up new fights over Obamacare. Still, the Senate's new filibuster rules requiring just 51 votes for confirmation make Burwell's path to nomination much easier.

Burwell, 48, graduated from Harvard College and Oxford University as a Rhodes Scholar. A West Virginia native, she received early support Thursday night from Sen. Joe Manchin, a moderate Democrat from her home state.

"Sylvia’s experience in both the public and private sector, matched with the bipartisan relationships she has built over the years, shows that she is a public servant ready to take on this country’s challenges," he said in a statement. "I am confident that her leadership will ensure that we enact commonsense fixes to the Affordable Care Act to help improve the lives of millions of Americans."

Sen. Chuck Grassley (R-Iowa), who pointed to Republican lawmakers' tense relationship with Sebelius, suggested the next HHS secretary will also face a challenge from the Hill over the health-care law.

"It’s disingenuous for the White House to distance itself from the problems and attribute them to partisan sniping at one member of the administration," Grassley said in a statement. "The next secretary might have a fresh start with the public and Congress but the flawed law is still the law.”

Lori Montgomery contributed to this report.

At the White House Friday, President Obama announced the resignation of Health and Human Services Sec. Kathleen Sebelius and nominated Office of Management and Budget Director Sylvia Mathews Burwell to take her place. (The Associated Press)

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